Gastric/duodenal ulcer disease

Question 1

How can peptic ulcer disease be classified?

Answer 1

acute and chronic

Question 2

Two causes of acute peptic ulcer disease?

Answer 2

drugs and stress

Question 3

Two drugs that can cause peptic ulcer disease

Answer 3

NSAIDs

steroids

Question 4

Two chronic causes of peptic ulcer disease?

Answer 4

drugs
H.pylori
Cancer
Zollinger-Ellison

Question 5

Three risk factors for duodenal ulcers?

Answer 5

  H. pylori (90%) 
  Drugs: NSAIDs, steroids 
  Smoking 
  EtOH 
  ↑ gastric emptying 
  Blood group O

Question 6

Three risk factors for gastric ulcers?

Answer 6

  H. pylori (80%) 
  Smoking 
  Drugs 
  Delayed gastric emptying 
  Stress e.g. sepsis, trauma

Question 7

How does gastric ulcer disease present in relation to duodenal ulcers?

Answer 7

Duodenal- epigastric pain before meals and at night, relieved by eating or milk

Gastric- Pain worse on eating, relieved by antacids, WEIGHT LOSS

Question 8

List three complications of peptic ulcer disease

Answer 8

1 Haemorrhage, therefore anaemia
2 Perforation
3 Gastric outflow obstruction
4 Malignancy

Question 9

Three investigations for peptic ulcer disease?

Answer 9

Bloods: FBC
C13 breath test
OGD
CLO/urease test for H.pylori
Gastrin

Question 10

Why would you check gastrin levels when investigating for peptic ulcer disease?

Answer 10

zollinger-ellison suspiscion

Question 11

Three conservative management options for PUD

Answer 11

  Lose wt. 
  Stop smoking and ↓ EtOH 
  Avoid  hot drinks and spicy food 
  Stop drugs: NSAIDs, steroids 
  OTC antacids

Question 12

Medical management of PUD?

Answer 12

 OTC antacids: Gaviscon, Mg trisilicate
 H. pylori eradication: PAC500 or PMC250
 Full-dose acid suppression for 1-2mo
 PPIs: lansoprazole 30mg OD
 H2RAs: ranitidine 300mg nocte

Question 13

Name two surgical options for PUD

Answer 13

1 Vagotomy (reduced acid secretion stimulation)
2 Antrectomy- distal half of stomach removed
3 Subtotal gastrectomy- performed occassionally for zollinger ellison

Question 14

Two complications of PUD surgery?

Answer 14

stricture
abdominal fullness
stump leakage
reflux
weight loss- malabsorption

Question 15

What is Zollinger Ellison syndrome?

Answer 15

hypersecretion of gastrin by endocrine tumour in pancreas or duodenum which increases gastric output and causes severe peptic ulceration